Facial Nerve Paralysis: Symptoms, Steroid Side Effects, and Concerns

Q: Facial Nerve Paralysis: Symptoms, Steroid Side Effects, and Concerns

Hello, You Ma：<br>You mentioned that "when drinking water, your lips cannot fully close, and your right face feels stiff when your mouth is wide open." You have been taking steroids and gastric medication for a week. <br>Clinically, this may suggest facial nerve paralysis. <br>In

Facial nerve paralysis

Hello Doctor, my daughter (15 years old) noticed on the afternoon of February 13 that she could not fully close her lips when drinking water, and her right face felt stiff when she opened her mouth wide.
She visited the doctor on February 14 and was prescribed steroids and stomach medication for a week.
During this time, she experienced side effects including frequent urination, seeing halos around lights, facial flushing, sudden dizziness, and fatigue.
By February 20, she had finished the steroid treatment and is currently only taking B12.
On the morning of February 21, she suddenly noticed soreness when pressing on both armpits, which gradually extended down to her waist and the outer thighs.
As of now (February 24), except for above the neck and the chest and back, all other areas feel sore upon pressure.
May I ask: 1.
What specific side effects from steroid use should we be particularly aware of? 2.
What could be the cause of the increasing soreness in her body? Is it related to the steroids? Should she return for a follow-up examination? Thank you for taking the time to respond.

You Ma, 40~49 year old female. Ask Date: 2022/02/24

Dr. Jiang Junyi reply Neurology

Hello, You Ma:
You mentioned that "when drinking water, your lips cannot fully close, and your right face feels stiff when your mouth is wide open." You have been taking steroids and gastric medication for a week.
Clinically, this may suggest facial nerve paralysis.
In the acute phase of facial nerve paralysis, symptoms may take some time to improve due to nerve damage.
The use of steroids in the first week is primarily to control inflammation and reduce the extent of nerve damage.
Other treatment options include vitamin supplementation, medications to improve blood circulation, as well as electrical stimulation, acupuncture, massage, low-level laser therapy, infrared irradiation, shortwave therapy, and facial muscle exercises.
Aside from steroids, there is insufficient evidence to support the effectiveness of other treatment modalities.
After the acute phase, there are almost no medications that have been proven to be helpful, and patients are advised to take vitamin B complex as an adjunct therapy.
For more information, you can refer to: https://www.youtube.com/watch?v=eyeMD2jNwI8&t=6s
You also mentioned that "on the morning of February 21, you suddenly noticed soreness when pressing both armpits, which gradually extended down to the sides of your waist and the outer thighs.
As of now (February 24), except for above the neck and the chest and back, all other areas feel sore when pressed." This does not seem to be a side effect of "short-term steroid use." Potential side effects of long-term steroid use include weight gain, moon facies, acne, buffalo hump, osteoporosis, and thinning skin.
Therefore, it may be necessary to consider infection or other issues.
Regarding "frequent urination + seeing halos around lights," I recommend arranging for urine and blood tests.
It would be advisable for you to visit a rheumatology or infectious disease clinic for further examination and to rule out related diseases.
Thank you for your inquiry.
If you have any further questions, feel free to discuss them!
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Hospital, cares about you.

Reply Date: 2022/02/24

More Info

Facial nerve paralysis, often referred to as Bell's palsy when idiopathic, can present a range of symptoms and complications that can be distressing for both patients and their families. In your daughter's case, the onset of symptoms such as the inability to fully close her lips and facial stiffness is indicative of facial nerve involvement. The treatment regimen of steroids, typically prescribed to reduce inflammation and swelling around the nerve, is common in these cases. However, the side effects she is experiencing raise important questions regarding the management of her condition and the implications of steroid use.

1. Steroid Side Effects: Corticosteroids like prednisone are effective in treating inflammation but come with a range of potential side effects. Common side effects include increased appetite, mood changes, insomnia, and gastrointestinal issues. In your daughter's case, symptoms such as frequent urination, visual disturbances (seeing halos), facial redness, dizziness, and fatigue are noteworthy. While some of these effects can be expected, particularly in the short term, they should be monitored closely. Frequent urination could indicate a possible impact on her adrenal function or fluid balance, while visual disturbances and dizziness warrant further evaluation to rule out other underlying conditions. It is essential to communicate these side effects to her healthcare provider, as they may need to adjust her treatment plan or provide supportive care to alleviate these symptoms.

2. Widespread Muscle Soreness: The development of muscle soreness in various areas of her body, particularly after the initiation of steroid therapy, raises a few considerations. While corticosteroids can lead to muscle weakness and changes in muscle metabolism, the pattern of soreness extending from her armpits to her thighs is not typical for steroid side effects alone. This could be indicative of a few different scenarios:
- Muscle Strain or Overuse: If she has been compensating for her facial paralysis by using other muscle groups differently, this could lead to soreness.

- Systemic Effects: Corticosteroids can affect muscle function and may lead to myopathy, but this typically presents with weakness rather than soreness.

- Other Underlying Conditions: The spreading soreness could also suggest a viral infection, autoimmune process, or even a reaction to the medication itself.
Given the complexity of her symptoms and the potential for overlapping conditions, it is advisable to schedule a follow-up appointment with her healthcare provider. They may consider conducting a thorough examination, possibly including blood tests or imaging studies, to rule out other causes of her symptoms.
In summary, while corticosteroids are a cornerstone in the management of facial nerve paralysis, their side effects can significantly impact a patient's quality of life. It is crucial to maintain open lines of communication with her healthcare team to address any concerns promptly. Additionally, monitoring her symptoms closely and seeking further evaluation for the muscle soreness is essential to ensure comprehensive care. Your daughter's health and well-being are paramount, and proactive management will help her navigate this challenging time.

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